Volume 6 • Issue 1 • 1000415 Open Access Research Article J AIDS Clin Res ISSN: 2155-6113 JAR an open access journal Pereira et al., J AIDS Clin Res 2015, 6:1 DOI: 10.4172/2155-6113.1000415 HIV Prevalence and HIV-Related Sexual Practices among Men Who Have Sex with Men in Portuguese Bathhouses Henrique Pereira 1,2 *, Samuel Monteiro 1 , Graça Esgalhado 1 and Rosa Marina Afonso 1 1 University of Beira Interior, Portugal 2 UIPES, Psychology and Health Research Unit, (ISPA-IU) *Corresponding author: Henrique Pereira, University of Beira Interior, Portugal, Tel: +351914572131; E-mail: hpereira@ubi.pt Received November 15, 2014; Accepted December 29, 2014; Published January 10, 2015 Citation: Pereira H, Monteiro S, Esgalhado G, Afonso RM (2015) HIV Prevalence and HIV-Related Sexual Practices among Men Who Have Sex with Men in Portuguese Bathhouses. J AIDS Clin Res 6: 415. doi:10.4172/2155-6113.1000415 Copyright: © 2015 Pereira H, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Keywords: Gay bathhouse; HIV prevalence; HIV risk behavior; Men who have Sex with Men (MSM) Introduction Gay bathhouses are businesses that provide an environment where gay men and other men who have sex with men (MSM) can meet to connect sexually and socially [1]. Te physical structure, architecture, and atmosphere of bathhouses vary from one space to the next, but each is constructed to meet the primary need of a safe place to meet other men for sex [2] or as a safe place for some men to just socialize with other men. Men who most frequently engage in high–risk sexual behavior go to a wide variety of places where men meet for sex (e.g., bars or public parks), as well as the bathhouses, that in Portugal concentrate in Lisbon, and Oporto, the largest cities. Although there are some men who will engage in high–risk behavior in any venue they frequent, recent data found that the majority of men who go to the baths do not engage in high–risk behavior in that setting [3]. Also, men who do frequent gay bathhouses share other concerns beyond HIV transmission as a salient component of bathhouse culture, such as moral conceptions of self and others at a bathhouse; identity management at a bathhouse; psychosocial functions of gay bathhouses, and bathhouses as critical environments for the promotion of safer sex activities among gay and bisexual men [4]. Since the global outbreak of HIV/AIDS, HIV has been transmitted among diferent vulnerable populations. In Portugal there are an estimated 41,035 HIV-infected individuals [5], and a prevalence rate of 0.82 (ages 15-49), being this one of the highest rates in Western Europe [6]. In addition, 81.7% of the people diagnosed with HIV were men, and although the highest rate of HIV infection is through heterosexual unprotected sex (38%) and intravenous drug users who share unclean needles (44.7%), approximately 12.4% of all infections were transmitted via homosexual and/or bisexual unprotected sex (these data refer to the cumulative percentage of HIV transmissions from 1983 to 2011) [%]. Tis is particularly important to mention given that this rate has doubled since 2001 among man who have sex with men (MSM) in Portugal, and these estimates only regard the notifed cases, not considering the unreported cases. Terefore, MSM remain one of the most at risk groups for HIV transmission [7]. Te use of highly active antiretroviral therapy (HAART) has signifcantly decreased HIV/AIDS-related mortality [8]. It has been reported that unprotected sex has increased among MSM afer the introduction of HAART, which has resulted in dramatic decreases in the morbidity and mortality from HIV infection [9]. Portugal provides free HAART to all HIV/AIDS patients, but although successful HAART can reduce the contagiousness of HIV, the fact that HIV transmission still occurs in the ART-era indicates that transmission occurs from undiagnosed, untreated, or unsuccessfully treated patients [8]. Abstract Background: To determine the perceived prevalence (the response of known HIV diagnosis) and trends of HIV infection among mem who have sex with men (MSM) frequenting gay bathhouses; and (2) to identify the risk factors associated sexual practices. Methods: A total of 424 MSM (Mean age 35.64, SD=10.05) recruited through informal social networks and the Internet participated in this study. Most participants were single and self-identifed as gay (66.7%). Participants were asked to recall their sexual experiences while visiting a bathhouse for sexual purposes. Results: 9.4% (n=40) of participants reported being HIV positive and approximately 14.5% (n=62) reported not knowing their status. MSM visited the bathhouses 1.76 times per month (SD=2.12) and involved themselves with 3 men (on average) per each visit. Statistically signifcant differences between having sex with or without a condom were found (p<0.001) refect that risky behavior occurs (95% CI). Risk practices involving fuid exchange (condom- less practices) were also reported. Ejaculation in the mouth was reported by 29.3% to 48.9% of all participants, and ejaculation in the anus was reported by 15.8% to 17.4% of all participants. Linear regression indicated that sex role, substance use, sexual orientation and number of monthly visits were predictors of sexual practices involving fuid exchange. Conclusion: Results from this study show that HIV prevalence and HIV-related practices is high among MSM who use bathhouses to engage in sexual activity, and this can serve as a reference for researchers interested in these behavioral patterns and for local authorities aiming to promote health education among MSM. J o u r n a l o f A I D S & C li n i c a l R e s e a r c h ISSN: 2155-6113 Journal of AIDS & Clinical Research